Health-Related Quality of Life (HRQOL) Assessment in Outcome Studies

1. Health-Related Quality of Life (HRQOL) Assessment in Outcome Studies Ron D. Hays, Ph.D. (drhays@ucla.edu) UCLA/RAND GCRC Summer Course “The Essentials of Clinical Investigation: Developing a Research Proposal” Gonda Building 1357 (July 14, 2008, 8-9 am) http://www.gim.med.ucla.edu/FacultyPages/Hays/

2. HRQOL is a Patient-ReportedOutcome (PRO) Process Of Care Health Outcomes Interpersonal Quality Technical Quality HRQOL Clinical

3. Process of Care • Expert Consensus • Quality of Care “If Then” Indicators • % of patients with diabetes with one or more HbA1c tests annually • Patient reports about communication • In the last 12 months, how often did your doctor explain things in a way that was easy to understand?

4. Health Outcomes • Clinical • % of patients with diabetes with most recent HbA1c level >9.0% ( poor control) • Patient global rating of health • Would you say that in general your health is: • Excellent • Very good • Good • Fair • Poor

5. Patient Characteristics Patient Behavior Process Of Care Health Outcomes Interpersonal Quality Technical Quality PRO Clinical

6. Health Services Research2008 Eisenberg Award

7. Health-Related Quality of Lifeis: • How the person FEELs (well-being) • Emotional well-being • Pain • Energy • What the person can DO (functioning) • Self-care • Role • Social

8. HRQOL Physical Social Mental HRQOL is Multi-Dimensional

9. HRQOL is Not • Quality of environment • Type of housing • Level of income • Social Support

10. In general, how would you rate your health? Poor Fair Good Very Good Excellent

11. Greater % of fair or poor health reported by older adults (33% for 75+ versus 9% for 18-34)

12. SF-36 Generic Profile Measure • Functioning • Physical functioning (10 items) • Role limitations/physical (4 items) • Role limitations/emotional (3 items) • Social functioning (2 items) • Well-being • Emotional well-being (5 items) • Energy/fatigue (4 items) • Pain (2 items) • General health perceptions (5 items)

13. How much of the time during the past 4 weeks have you been happy? None of the time A little of the time Some of the time Most of the time All of the time

14. Does your health now limit you in walking more than a mile? (If so, how much?) No, not limited at all Yes, limited a little Yes, limited a lot

15. 0-10 Scoring of HRQOL Scales • Average or sum all items in the same scale. • 0 (worst) to 100 (best) possible range (linear) transformation (original score - minimum) *100 X0-100= (maximum - minimum)

16. The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? • Vigorous activities, such as running, lifting heaving objects, participating in strenuous sports • Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf • Lifting or carrying groceries • Climbing several flights of stairs • Climbing one flight of stairs • Bending, kneeling, or stooping • Walking more than a mile • Walking several blocks • Walking one block • Bathing or dressing yourself • Yes, limited a lot ------> 0 • Yes, limited a little ----> 50 • No, not limited at all -->100

17. Change in Physical Function My score today = 100 Intervention #1: • Hit by Rock results in being limited a little in vigorous activities • Post-intervention score: 95 ( - 0.25 SD) Intervention #2: • Hit by Bike results in me being: • limited a lot in vigorous activities and in climbing several flights of stairs • limited a little in moderate activities • Post-intervention score: 75 (- 1.25 SD) Mean = 87 (SD = 20) 75th percentile = 100 (U.S. males)

18. SF-36 Physical Health Physical Health Physical function Role function-physical Pain General Health

19. Mental Health Emotional Well-Being Role function-emotional Energy Social function SF-36 Mental Health

20. SF-36 Physical Health (PCS) & Mental Health (MCS) Summary Scores PCSz = (PF_Z * .42402) + (RP_Z * .35119) + (BP_Z * .31754) + (GH_Z * .24954) + (EF_Z * .02877) + (SF_Z * -.00753) + (RE_Z * -.19206) + (EW_Z * -.22069) MCSz = (PF_Z * -.22999) + (RP_Z * -.12329) + (BP_Z * -.09731) + (GH_Z * -.01571) + (EF_Z * .23534) + (SF_Z * .26876) + (RE_Z * .43407) + (EW_Z * .48581) PCS = (PCS_z*10) + 50 MCS = (MCS_z*10) + 50

21. T-Scores • Fix mean and SD in sample or with respect to a reference population: • z-score (mean = 0, SD = 1) • T-score (mean = 50, SD = 10) (X – sample or population mean) Zscore = SDX Y = target mean + (target SD * Zx)

22. Burden of Diabetes Compared to other Conditions and General Population Hays et al. (2000), American Journal of Medicine

23. (n=676) (n=754) (n=1181) (n=609) PCS Predictive of 5-Year Mortality % Dead SF-36 Physical Health Component Score (PCS)—T score Ware et al. (1994). SF-36 Physical and Mental Health Summary Scales: A User’s Manual.

24. Kidney-Disease Targeted Items • During the last 30 days, to what extent were you bothered by each of the following. • Cramps during dialysis ? • Feeling washed out or drained? Not at all bothered Somewhat bothered Moderately bothered Very much bothered Extremely bothered

25. Preference-Based Measures Cost  Effectiveness 

26. Is New Treatment (X) Better Than Standard Care (O)? X 0 X 0 Physical Health X > 0 Mental Health 0 > X

27. Medicine Use Diminishes HRQOL? Medication Person Use HRQOL (0-100 scale) 1 No dead 2 No dead 3 No 50 4 No 75 5 No 100 6 Yes 0 7 Yes 25 8 Yes 50 9 Yes 75 10 Yes 100 • Groupn HRQOL • No Medicine 3 75 • Yes Medicine 5 50

28. Survival Analysis Dead = 0.0 Runner and person in coma = 1.0

29. Quality of Life for Individual Over Time

30. Perfect Health Bad as being dead

31. HRQOL Satisfy Reliability Minimum Standards 0.70 or above (for group comparisons) Hahn, E. A., Cella, D., Chassany, O., Fairclough, D. L., Wong, G. Y., & Hays, R. D. (2007). Precision of health-related quality of life data compared with other clinical measures. Mayo Clinic Proceedings, 82 (10), 1244-1254.

32. Thank you